1. Self-Assessment, Lifelong Learning, & Assessment of Performance in Practice: Maintenance of Certification for Family Physicians Parts II &IV David Price, MD Colorado Permanente Medical Group Associate Professor Family Medicine UCSHC Chair-elect, American Board of Family Medicine MedBiquitous April 2007

3. ABFM Mission Encourage excellence in medical care Thru certification/recertification process, provide patients the assurance that certified FPs have necessary training & experience to provide quality care to individuals and families Commitment to excellence is maintained throughout physician’s years of practice

4. ABFM purpose Establish & maintain stds of excellence in FP Improve standards of medical education for FP training Determine by evaluation the fitness of FP specialists who apply for & hold certificates

5. MOC Response of ABMS & member boards to quality concerns & gaps Multiple stakeholders (patients, FSMB, AMA, ACCME, physicians, etc.)

6. Components of MOC (MC-FP) I. Professionalism II. Periodic self-assessment (SAM*) Knowledge assessments (KA*) Clinical Simulations (ClinSim*) CME III. Cognitive expertise (Examination) IV. Practice-based learning & improvement PPM MIMM Pt-Clinician Communication Pt Safety module

7. Extend Certification From 7 to 7+3 Years Old: 6 SAMs + 1 PPM then exam year 7 NOW: Diplomates engaged/remaining in MC- FP process can extend certificate to 10 years by completing MC-FP requirements in 3 blocks: 2 SAMs + 1 PPM per 3 year block x 3 blocks with exam in 10th year.

8. Part II (SAMs + Simulations) 2004: DM, HTN 2005: CAD, Asthma 2006: Depression, Heart Failure 2007: Well child care, Pain management 2008: Health behavior change, Maternity care Eventual choice from about 20 modules

9. SAM: Diabetes Mellitus Diagnosis5 quest. Recognition/mgmnt. macrovasc. Compl.10 quest. Recognition/mgmnt. microvasc. Compl.10 quest. Non-pharmacologic mgmnt5 quest. Pharmacologic mgmnt15 quest. DKA/HONK mgmnt5 quest. Clin. Impl. Insulin resistance5 quest. Prevention5 quest.

10. SAM: Hypertension Dx/risk stratification of patient w/HTN5 quest. Recognition/mgmnt hypertensive crisis5 quest. Regognition/eval of secondary HTN10 quest. Nonpharmacologic management5 quest. Pharmacologic management15 quest. Mgmnt HTN with comorbid illness10 quest. Mgmnt HTN in special populations (elderly, pregnancy, African Americans) 10quest.

11. SAM: Asthma Pathogenesis5 quest Diagnosis5 quest Chronic asthma management20 quest Acute asthma management15 quest Co-morbidities of asthma5 quest Exercise-induced asthma5 quest Complications of asthma therapy5 quest

12. SAM: CAD Pathogenesis5 quest Diagnosis10 quest EKG Interpretation5 quest Chronic CAD Management15 quest Acute coronary syndromes10 quest Recognition/management acute MI & complications 15 quest

17. ABFM Self-Assessment Modules: Completion Time

21. Changes Resulting from Diplomate Input Questions printable for initial completion off line (“pre-test”) Only incorrectly answered questions appear upon completion On-line full text references for questions Direct link to references from questions

22. More Changes Resulting from Diplomate Input Educational critique (basis for question) Available for correct answers once SAM done Available on second attempt to answer questions until more diplomates have web access

23. More Changes Resulting From Diplomate Input Easier navigation MAC interfaces “SAM” roadmap ABFM Exam committee final review of questions prior to release Change modules without fee if answered less than 15 questions

24. Even More Changes Resulting From Diplomate Input New evaluation forms at end of modules Option to upload CME to AAFP after evaluation by entering AAFP ID# “In-between” visit chart review on simulations – interval history, lab review Abnormals from previous visit display on right side of simulation for quick review

59. CME Process vs. QI cycle Needs assessment Objectives Implementation Evaluation Follow-up Plan Do Study Act Price D. Continuing medical education, quality improvement, and transfer of practice. Medical Teacher 2005;27(3): 259-268.

60. Part IV Patient-based, physician controlled improvement model (HTN, DM, CAD, asthma, depression, HF) 6 or more quality indicators per condition Practice audit 10 charts/patients Feedback vs. peers & benchmarks Select area(s) for improvement Develop QI plan (from a “QI wizard”) Re-audit (PDSA) 10 charts/patients

75. I hope this has been an eye opening experience